LSA Audit 2012/13

* Heart of England NHS Foundation Trust

Supervisors of Midwives Survey

529%

953%

318%

How many midwives do you currently supervise ?

0 - 5 (a)5 - 10 (b)10 - 15 (c)15 - 20 (d)20 - 25 (e)25 + (f)Other

16%

1165%

529%

How many of the midwives in your caseload have received a supervisory review in the last year

100% (a)75 - 99% (b)50 - 74 % (c)Less than 50 % (d)

617%

26%

1131%

514%

514%

514%

If you were unable to meet any of them, what was the reason ? Please indicate from the following answers.

Your own Long Term Sickness or Absence (a)Supervisee Long-term Sickness or Absence (b)Midwife did not confirm (c)Offered appointment postponed or cancelled by the Su-pervisee (d)Offered appointment postponed or cancelled by your due to other work pressures (e)Maternity Leave (f)Other

How satisfied were you with the following ?

741%

47%

12%

Venue

1165%

29%

6% Privacy

953%8

47%

Timing

1376%

24%

Confidentiality

Good (G)Fair (F)Poor (P)

1165%

635%

Content

24%

65%

6%6%

How often (on average) would you say that midwives approach you for advice or support ?

Once a week (a)

Once a month (b)

Only at the supervisory review (c)

Not at all (d)

Other

94%

12%

24%

29%12%

6%

How are midwives provided with 24 hour access to a supervisor of midwives ? Tick all that apply.

24 hour on call via switchboard (a)

Via Labour Ward Rota (b)

Your own SOM personal mobile (c)

Email (d)

All of these (e)

Other

100%

100%

71%41%100%

59%

88%6%

Please could you list the things that you discussed with you su-pervisees at their supervisory review

(Tick all that apply)

ITP & PREP Guidance (a) Professional Development and gaining competencies (b)

Lack of confidence in practice (c) Extended sphere of pracatice (d)

Record Keeping and Audit of Records (e) Attitude, Bullying and Professional Behaviour (f)

Debrief and support following an untoward investigation (g) Other

1376%

318% 1

6%

How have you audited the record keeping of your supervisees dur-ing the last year ?

One to one basis (a)Self Review (b)Peer Review (c)Group Review (e)Not audited (d)Other

59%

35%

24%

6%12%

How do you ensure appropriate feedback and action following audit-ing records

I note in the paper supervisory record (a)

I note on the LSA Database and print amd print off for the midwife (b)

I make a further appointment to follow up at the end of the review (c)

I don't follow up (d)

Other

First Second Third Fourth Fifth Sixth Seventh Eighth Nineth Tenth Eleventh Twelth0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

41%

29%

6%

18%

6%

6%

12%

12%18%

12%6%

12%

6%

18%

24%18%

35%

12%6%

6%

12%

6%

24%

18%

18%

6%

6%

6%12%

12%

6%

12%

12%

18%

6%

6%

6%

6%

6%

6%

18%

6%12%

6%

18%12%

6%12%

6%

6%

6%

6%

6%

6%24%

29%

6%

12%

6% 6% 6%

12%

6%

6%

6%

53%6%

35%

6%

12%

18%12%

6%

6%

12%

12%

29%

18%

6%

12%6%

6%

6%

6%

18%

18%12%

29%

6% 6%

18%

6%

76%

Please prioritise (1-12) the roles listed to describe how you see youself as a Supervisor of Midwives

Supporter (a) Counsellor (b) Inspector (c) Friend (d) Mentor (e) Preceptor (f)Monitor (g) Advisor (h) Guide (i) Disciplinarian (j) Proactive (k) Leader (l)

Please prioritise the listed functions of supervision of midwives in order of importance

First Second Third Fourth Fifth Sixth Seventh Eighth Nineth Tenth Eleventh0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

100%

0%

18%

12%

12%18%

12%

18%

6% 6%

41%

6% 6% 6%

24%

6% 6% 6%

29%

24%18%

18%12%

6%

6%35%

12%

29%

6%

6%

6%

24%

6% 6%

29% 6%

12%

6%

6%

29%

18%

41%

12%

6% 6%12%

24%

18% 18%

12%6%

12%

18%

29%24%

18%

24%

12%

29%35%

12%

29% 29% 29%

Protecting the midwife (a) Enabling midwives to improve their practice (b) Safeguarding public interest (c)Professionally developing midwives (d) Counselling (e) Giving guidance and support (f)Giving professional support (g) Inspecting equipment, documentation and drug storage (h) Providing professional leadership (i)Ensuring regular updating and study days (j) Providing access to policy (k)

635%

1059%

16%

How often do you meet with your LSA Midwifery Officer

No answer

Never (a)

0 - 6 months (b)

7 - 12 months (c)

1 - 2 years (d)

6%6%

94%

88%

12%

35%6%

To whom do you go to for advice and support in relation to your supervisory function ?

Tick all that apply

Head of Midwifery (a)

RCM (b)

Supervisor Colleague (c)

LSA Midwifery Officer (d)

NMC (e)

NMC Resource Pack (f)

Other

17100%

Are you confident in the support from the LSA

Yes (Y)No (N)

1637%

1535%

1228%

How do you contact the LSAMO. Tick as many as apply.

Phone (a)

Email (b)

LSA Office Administrator (c)

I find it difficult to contact the LSAMO (d)

Other

65%

18%

94%

6%

65%

53%

For what reasons do you contact the LSA office ?Tick all that apply.

Booking study events (a)

POSOM programme (b)

Supervisory Investigations (c)

PREP Guidance (d)

One to one discussions with LSAMO (e)

General advice (f)

Other

1257%

15%

733%

15%

How do you as a Supervisor of Midwives have the opportunity to contribute to the development /review of guidelines for prac-

tice ?

I have already been part of a guidelines group as a SOM (a)I would like to participatre in a future guideline group as a SOM (b)Guidelines should be discussed at the SOM meetings (c)I have never commented on guidance (d)Not interested (e)Other

10

10

20

30

40

50

60

70

80

90

100

84 84

78

86 86

88

58

34

% Of Midwives Attending Skill Drills Workshops in...

Shoulder Dystocia Breech Delivery [Adult Resuscitation Neonatal ResuscitationCatastrophic Haemorrhage CTG Interpretation Normality Workshop Waterbirth

59%

41%24%24%

41%

18%

In relation to the wider role of supervision of midwives, please indicate in which activities you have been involved in your Trust

?

Contributing to Trust policies (b)Planning schemes to empower midwives (c)Enabling midwives to prepare for new roles (d)Providing expert advise to outside agencies (e)Acting as a catalyst for change (f)Advising on commissioning maternity services (a)Other

1694%

16%

Do you feel confident in investigating poor practice

Yes (Y)No (N)

17100%

Have you attended an Investigation Workshop provided by the LSA ?

Yes (Y)No (N)

1694%

16%

Do you receive enough help and advice from the LSA during supervisory investigations?

Yes (a)

No (b)

I have not undertaken a supervisory investigation (c)

Please rate your confidence in the following :

318%

1482%

Undertaking an investigation

318%

1271%

212%

Preparing a supervisory investigation report

212%

1165%

424%

Conflict Handling

741%

1059%

Supporting a midwife through an investigation

Very confident (V.)Fairly confident (F.)Not confident (N.)

212%

1059%

529%

Planning and evaluating a supervised prac-tice programme

953%

847%

Have you facilitated a reflective activity for midwives during the last year ?

Yes (Y)

No (N)

24%

88%

76%6%

65%

24% 6%

Is there anything within your Trust which inhibits you or your team in undertaking your role as Supervisor of Midwives ?

Little notice for SOM Meetings (a)Lack of protected time (b)Unit is too busy (c)SOM team is disorganised (d)No access to a private room (e)No access to a computer (f)Don't know how to use the LSA Database (g)Other

1376%

424%

Does the service provide and allow protected time for Supervision of Midwives

Yes (Y)

No (N)

47%

41%

6%6%

What is your substantive role ?

Midwife (a)

Midwifery Manager (b)

Midwife Team Leader (B7) (c)

Specialist or Consultant Midwife (d)

Head of Midwifery (e)

Midwife Teacher (f)

Self Employed or Independant Midwife (g)

Other

53%

635%

212%

How long have you been a Supervisor of Midwives

0 - 5 Years (a)

5 - 10 Years (b)

10 - 15 Years (c)

15 - 20 Years (d)

20 - 25 Years (e)

30 + Years (f)

Other

How do you work in partnership with women ?

1694%

16%

With a individual and her family

1059%

741%

With representative groups

529%

1271%

Other

Yes (Yes)No (No)

18%

76%

41%

65%

18%

Have you in the last year provided support to women/midwives were there has been difficulty in achieving care choices ?

Women wanting to change their named midwife (a)

Women wanting to make a complaint (b)

Women wanting to birth at home against guidance (c)

Women wanting a debrief following a birth event (d)

Other

1482%

318%

Do you feel confident in challenging poor attitude

Yes (Y)

No (N)

Are you confident in supporting midwives requiring: 

1588%

212%

Supervised Practice

Yes (Yes)No (No)

17100%

Developmental Supported Practice

Yes (Yes)No (No)

Are you confident in supporting midwives to support women who want home births against advice ?

Yes (Y)

No (N)

What have you found rewarding/challenging in being a Supervisor in the last 12 months?

As I am still new to the challenge of supervision it is too early to say what I have found rewarding as my supervision journey is ongoing. It has been a time of change and turbulence as supervisory colleagues have become disillusioned and resigned.

Undertaking SOM investigation was a challenge but resulted in a good outcome for the midwives so that was rewarding and also rewardingto know the investigation was goodThe increasing numbers of supervisory investigations. Feeling more confident when undertaking investigations

Rewarding: appreciation from midwives when supporting them through difficult situations. Challenging: reminding management that the roles differ. Combining the increasing number of investigations with the day job. Feels like holding down 2 full time jobs.

rewarding- supporting my supervisees, growing as a body of supervisors and therefore being more proactive challenging- learning to work with managers but knowing when to stand my ground as a somOnly my newly gained experience in supervised practice program support. Nil else.

rewarding - being there to support colleagues when issues arise challenging - finding the time to achieve a totally effective role as a supervisorUndertaking investigations

Enjoy one to one with Supervisee's Challenging is the lack of time to undertake supervision

Being approached for support and guidance very rewarding and being able to provide. Juggling work commitments, management and supervision. Always playing catch-upfinding time to complete notes reviews and investigations have been challanging, however I spoke to a new group of midwives about supervision and that was fantastic!Rewarding - seeing midwives develop, enhance their practice. Challenging the time to aprticipate in supervised practice programmes effectivleyThe challenge of managing a busy community caseload and the management of the team and finding time for supervision.

sucessful supervised practice programme

enjoy investigations where I have identified good practice and been able to let the midwives involved know.

Being supportive and a guide to development of midwives. I have found time to complete SOM activities challenging.

Supporting midwives through developmental/ supervised programmes, with a successful outcome.

How have you demonstrated your leadership skills as a supervisor?

I hope I lead by example. That I am professional, supportive and available for advice by both the women and their families and by my midwife colleagues.

Supported Change in practice within unitSupporting good practice, whilst challenging poor practice. supporting changeSupportive and work towards encouraging midwife to find the solutions to their problems/issues.through reminders withthe support of clinical riskBy ensuring that I lead by example and by ensuring that all my supervisees are waware of their proffesional responsibilities and requirements.

supported colleagues within the trustBy supporting the midwives in the unit through busy periods. By helping to change ways of working to provide more support for staff

Sharing lessons learned from incidents. Working clinically with staff when the unit is busy. Advising staff on best practice and challenging unsafe practice when I see it.

Hopefully a visible supervisor, willing to challenge and support changeI actively participate at our meeting as well as at most of the risk meetings. I'm part of the team of SOMs that regularly do a session at mandatory days.

Offereing guidance Support Role model Encourager / motivatorUnsureBy supporting and facilitating home births against adviseChallenging management decisions and being an advocate for midwives in a professional mannerI believe I have demonstrated leadership by challenging poor practice and negative attitudes. I also believe providing direction into improving services with the resources available is vital.

Being a role model for other midwives. Offering advice and encouragement to newly qualified midwives. Ensuring clinical area safe. Promoting supervision positively

How do you as a SoM promote women centered care ?

In my daily contact with the women in my care I encourage dialogue that enables them to make informed choices and discuss their expectations about labour, delivery and the post natal period.

promote and provide choices for women within the unit.e.g facilities and pathways review policies and proceduresdevising plan of care for women whose birth choices does not meet the trust guidelines. Also meeting the women following delivery to discuss their delivery and to ensure that their birth choices were achieved. Also been part of the trust guideline group

Reminding midwives the focus of the midwifery role is to be with women although this is challenging faced with the changed culture which is steering midwives to work defensively instead of with the woman and her baby as the focal point of care.

by being a role model through my own clinical acreBy ecouraging women to take a role in the planning of their own care. By promoting midwifery care and home birth. By encouraging midwives to use their skills more in managing normal labour, to try to reduce the need for doctor involvment.

assist colleagues where needed and practice individualised careBesides listening to women through complaints and supporting staff and patients through incidents/ adverse outcomes/ making choices, I don't do anything differently as a SOM than as a RM

Always highlight the needs of the mother and baby as a priority when changes in practice or guidelines are planned.Ensuring staff are aware are the woman and her family are why we are here, they are our unique customers, who deserve the best individualised care in order to create optimum customer satisfaction. I na safe enviroment

During annual reviews, when meeting with my HOM and in my day to day role as a clinical midwifeContact with midwives TeachingEncouraging and supporting midwives and women with thsie choice of birth units for place of birthI promote woman centred care within my daily practiceKeep women and their families informed of all aspects of their care and ensure midwives are supported wellListening to the women. collecting feedback through questionnares. Complaints. Looking for trends.Promoting safe midwifery practice. offering women choices within their midwifery care

Please give any other comments you have about supervision in your unit

I have no further comment at this time.within our local group we have a heart for supporting women and their families aiming to provide excellent facilities and choice as well as ensuring midwives attain and maintain competence and best practice and feel supported we work well as a local teamSupervision within the unit has undergone a process of change, with increasing number of investigations. The supervisory team is becoming a more cohesive and supportive group,Challenging at moment since change in management structure. Midwives are feeling demoralised and fearful of the disciplinary punitive culture that has developed- very knee jerk reactions without finding out facts.we could perhaps "market" supervision much better although we now have a place on the intranetSupervision is stressed in this current climate, and often feels more punitive.i believe supervison has been through a tough period where colleagues questioned the support/role of supervision as we were often seen/referred to as 'policing' rather than supporting, but this thought is gradually changing back to a more postive look on supervisionAs a supervisory group we have been through a period of turmoil! But I believe we are coming through this and are working more cohesively as a group togetherGreat SOM team some very proactive and positive SOM's. We have achieved alot in the last 12 months mainly due to the contact SOM having time and the support of the HOM with this.Succession planning and recruitment is key to ensure the future of optimum maternity services in a safe environment and midwife job satisfactionI feel that we could me more positive and a little less divisive with the midwifery teamsDifficult to have a cohesive team of supervisors of midwives becasue of cross site work, lack of availability of supervisors of midwves at meetings. Also the increased number of investigations has increased the workload which means supervision is reactive rather than proactive.

At present there is a feeling of being overwhelmed as we have had several supervisors step down/ leave and currently there are no ne and up and coming SOMs to replace themsupervision within our unit is gradually become cohensive, and fairWhen I first joined the SOM team it was very 'cloak and dagger' but this was raised and we have all learnt from itI have no other commentsAs unit is very busy i dont think supervision is given the time that it requires to be positve and effective.

Please comment on what further assistance the LSA could provide for you

When the time comes I know that I will have the confidence to access any advice that I need.1

to continue with the support that they are currently providingContinue to be as supportive as always.continueNoneas suggested earlier to provide supervisors with adequate time to support supervisees and share what supervision is about - self promote, which in-turn may assist with the uptake of POSOMs

Guidance on tackling poor attitudeEncourage the Trust to support supervision by giving us time to be able to do it effectivelyI feel well support by fellow supervisors and the LSAI'm happy the the current level of support although I hope that they could continue to facilitate away days for SOMS

1:1 meetingTo continue to provide the support and adviselsa very supportivenil at presentNo further assistanceContinue with LSA study events. Be easily accessible.

65%

41%53%

12%

29%12%

Which websites have you accessed in the last week ?

Any LSA website (a)

Royal College of Midwives (b)

Nursing & Midwifery Council (c)

Any local university provider (d)

Department of Health (e)

Other